Arrogance

The word came up in two separate conversations, from two very different people. Every two weeks, we ask someone associated with ACPE to spend 45 minutes sharing his/her insight on the trends occurring in health care. Both people are nationally known, one a recruiter, the other a physician leader. With the number of physician leadership roles growing rapidly in the past few months, I want to share their comments because they’re important for both job seekers and leaders who plan on staying in their current organizations.

The recruiter said physicians seeking a new position for all the wrong reasons are spotted very quickly in the process. These physicians often say they’ve discovered how talented they are in management and know they would be successful in their first full time management role. They haven’t invested in management training because they possess “natural talent”, are highly critical of the leadership of their current organization and say they no longer enjoy clinical work. The term the recruiter used to describe their demeanor? Arrogant. Further, these doctors are quickly dropped from candidacy.

What does arrogant mean? Here are a few definitions – none of them conducive to effective leadership! “Overbearing pride evidenced by a superior manner toward inferiors.” “Haughtiness.” “Contemptuousness – the manifestation of scorn and contempt: every subordinate sensed his contemptuousness and hated him in return.” “The trait of being imperious and overbearing.”

The other guest, a health system physician CEO, said over the years he had to fire several excellent clinicians who had very poor communication skills and lacked self-awareness. They often had very good analytic abilities, great insight into problems and solutions, but could not manage a civil word with peers, subordinates or superiors. Some were friends. Again, the term arrogant was used to describe their behavior.

With teamwork replacing autonomy and independence, arrogance is a trait that will derail you and your career. It’s OK to be proud of your achievements as a physician, but it should come across as quiet confidence to others on the health care team. Some physicians DO have a natural talent for leadership and business. Most of us, however, must learn new concepts and behaviors we weren’t taught in our medical training. I’ve heard stories from coaches and mentors about successful behavior change in arrogant physicians who recognized how they were being perceived, and sought to change. Some of my most valuable experiences have been helping smart, talented physicians change their behaviors.

If you’re one of the hundreds of physicians who are looking for a rewarding role in leadership or management, be sure your first interview puts you in the best possible light. We want you to be successful. Many people are watching and curious about the impact of more physician leadership in the health care industry.

Notes from the road: An optimistic view of the future

Physicians are preparing to lead health care change across the country. This is perceived by some entrenched interests to be a threat. To patients and their families, and to physicians’ co-workers, this is a very positive development. I think whoever is closest to patients and consumers will be in the best position to impact change.

Crisscrossing the country over the past few weeks, here’s what I’ve seen and heard to justify my optimism. In Iowa, a large predominately rural health system has launched its Physician Leadership Academy. Each of the thirty-seven physicians were enthusiastic about learning how to improve dysfunctional work processes, develop innovative strategies, and find ways to improve patient outcomes of care. The initial class was nearly 50 percent larger than anticipated, and next year’s new class is equally committed and talented.

In South Carolina, the hospital association and medical association held a joint meeting to discuss what health care reform means for their communities. I talked with several ACPE members during that meeting. I learned that South Carolina has been collaborating with Atul Gawande on the surgical checklist project and with IHI on quality initiatives. The sense of common purpose and respectful disagreement on issues (not people or motives) between the medical society and the hospital association was very impressive. When it comes to interdisciplinary teamwork and measuring health care outcomes, I think South Carolina is a special place.

In Nevada, a large physician group has been managing financial risk for a few years, and doing very well. I listened to a sophisticated conversation at breakfast between two of the attendees about the clinical and financial management of heart failure patients across the continuum. I assumed both were physicians. Wrong. One was the CFO. I believe these kinds of conversations will become commonplace in integrated systems, ACOs, and medical homes if health care change continues in that direction.

In Nebraska, a rural community is beginning an important dialogue with its hospital board, independent and employed medical staff, and hospital staff about how to become a “physician led system, managed by business professionals”. Everyone will have to imagine how their roles will change, and what it means for relationships with large tertiary care centers in nearby cities.

In San Antonio, Texas several dynamic young physician leaders from different branches of the military remind me that some of the best teamwork training and practice occurs in our armed forces. When an individual fails, the whole team fails. They hold both individuals and teams accountable for serious safety events. They correct the problems that lead to the adverse outcomes.

If you see a system around you that frustrates you, or isn’t good for safe and reliable patient care, start now to learn what you can do to change it. Your satisfaction in helping to lead change, and see your role as a physician in a new perspective, will give you exciting new options in your career.